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Course: Adenopathy and an Extensive Skin Patch Overlying a Plasmacytoma Syndrome

CME Credits: 1.00

Released: 2023-12-20

A woman in her 60s presented to the dermatology office with a violaceous sclerotic plaque on her back. Based on previous biopsy results that suggested a diagnosis of morphea, she was treated with topical and systemic corticosteroids. However, the lesion enlarged, and a central cobblestonelike mass emerged (Figure, A). Results from an additional skin biopsy revealed dermal fibrosis and increased capillaries. As the biopsy specimen did not provide a conclusive diagnosis, magnetic resonance imaging was performed, which revealed a bone lesion on the spinous process of the L3 vertebra underlying the skin mass (Figure, B) and multiple sclerotic and lytic bone lesions with enlarged lymph nodes. A biopsy specimen of the bone lesion showed a dense infiltration of clonal plasma cells, suggesting the diagnosis of adenopathy and extensive skin patch overlying a plasmacytoma (AESOP) syndrome. The patient reported numbness in her hands, and serum protein electrophoresis results revealed elevated free levels of light chains and M-spikes. The patient received radiotherapy to the L3 vertebral lesion and underwent autologous stem cell transplant with high-dose melphalan. After achieving a complete hematologic response, the skin lesion showed substantial improvement.


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